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See a sample rate comparisonCPT 42450 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Excision Sublingual Gland
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $471.96 national non-facility rate (2026) · View Medicare rates for 42450 |
| Medicaid Fee Schedule | $376.94 median of the 8 states in the free preview · View Medicaid rates for 42450 |
National average reimbursement for CPT 42450 by major payers:
$585.27
$602.95
$657.19
$596.87
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CPT 42450
5 of 25 sample ratesHigher to lower in this preview
Carolina Regional Surgery Center. Ltd
Carolina Regional Surgery Center Ltd
$6,649.00Published rateLebanon Endoscopy Center LLC, Lebanon Endoscopy Center
Lebanon Endoscopy Center LLC
$2,353.00Published ratePacific Ritz Surgery Center, LLC
Pacific Ritz Surgery Center LLC
$1,540.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$1,283.00Published rateAysha Khan
Deaconess Hospital Inc
$797.90Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 42450 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42450 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 42450 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 42408-CPT | Moderate | Exc Sublingual Salivary Cyst |
| 42409-CPT | Moderate | Treat Cyst Of Saliva Gland, Surgery To Treat A Pocket Of Fluid (Cyst) Located On The Floor Of The Mouth To Allow For Drainage From A Gland Under The Tongue. |
| 42425-CPT | High | Xcision Of Parotid Tumor/Parotid Gland; Total En Bloc Remval, Excision Of Parotid Tumor Or Parotid Gland; Total En Bloc Removal Wit |
| 42450-CPT | Moderate | Excision Sublingual Gland |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42450. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42450 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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